Lorain Dentist - Patient Forms

Of the first 4 forms below, download and print the forms that apply to you. Bring the completed forms with you when you come for your appointment.

Adult new patient form

Child new patient form

Acknowledgement of receipt of notice of privacy practices and communications
The Notice of Privacy Practices can be obtained below.

Financial Policy

The following forms are available for your inspection. If you desire or are instructed by Dr. Weitz or someone from his staff, copy and print these forms to bring to your scheduled appointment.

Notice of Privacy Practices

Authorization for release of records

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